July 3, 2019 | | JFAS | Contact Us

ACFAS Holiday Hours

The ACFAS offices will be closed Thursday, July 4, and Friday, July 5, for Independence Day. The office will reopen on July 8. We wish all our members a safe and happy 4th of July holiday.

News From ACFAS

New Infographic Now Available
A new marketing Infographic entitled Weekend Warrior Warning – perfect for sharing on your social media, website or as an office poster – is now part of the Marketing Toolbox on

Aimed at amateur athletes, Weekend Warrior Warning cautions patients to start slowly and pay attention to their bodies when starting athletic activities. Most importantly, it reminds them to make an appointment if foot and ankle issues are limiting their activities, too.

ACFAS infographics are great marketing tools you can use to keep in touch with existing patients or to help find new patients.

Visit to access Weekend Warrior Warning. Check the Marketing Toolbox regularly for more patient education and practice marketing resources.
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Submit to Your Journal, JFAS
When you are thinking about publishing your original research, think of The Journal of Foot & Ankle Surgery first. By publishing in JFAS you help to show foot and ankle surgeons as true trailblazers in the medical community – developing new techniques with better outcomes for patients across the specialty.

Submit your articles in a traditional subscription format or through Open Access, which makes your research available free to millions of readers worldwide — including non-subscribers, health reporters and news outlets. ACFAS members receive a 50 percent discount on Open Access submissions.

Uncertain about publishing? The Elsevier’s Researcher Academy has great e-learning modules to help physicians determine how to prepare for and write their research, with helpful articles on the pre-submission editing process, securing funding, and more.

To submit an article, visit Also, use the JFAS Guide for Authors as your roadmap to submission; it offers formatting guidelines and serves as your “what to expect when submitting” handbook.
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Foot and Ankle Surgery

Influence of Tibial Component Position on Altered Kinematics Following Total Ankle Arthroplasty During Simulated Gait
Researchers compared ankle and hindfoot kinematics pre- and post-total ankle arthroplasty (TAA) during simulated gait and determine to what degree tibial component position correlated with variations in ankle kinematics. Eight midtibia cadaveric specimens were utilized for the study. The stance phase of gait was simulated both pre- and post-TAA in each specimen using a 6 degrees of freedom robotic platform. Ankle and hindfoot kinematics were measured from reflective markers attached to bones via surgical pins. The effect of tibial component position on absolute differences in ankle kinematics was assessed using linear regression.

No differences were observed in ankle sagittal and coronal plane motion between the intact and TAA conditions. Differences in ankle joint kinematics were identified in the transverse plane, where internal talar rotation was significantly increased following TAA compared with the native condition. The medial-lateral position of the tibial component was found to correlate with the altered transverse plane motion observed after TAA. No significant differences in subtalar and talonavicular joint kinematics in any plane were observed comparing the pre- and post-TAA condition.

From the article of the same title
Foot & Ankle International (06/27/2019) Saito, Guilherme H.; Sturnick, Daniel R.; Ellis, Scott J.; et al.
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Modified Valenti Arthroplasty in Running and Jumping Athletes with Hallux Limitus/Rigidus: Analysis of 100 Procedures
Researchers presented the results of 100 modified Valenti procedures, evaluating, among other factors, the ability to return to activity (RTA), decreased desired activity level, and need for additional surgery. Inclusion criteria included athletes who have exhausted conservative care without relief of daily pain, dorsiflexion <20° and grade of two or more. RTA for the 89 procedures where exact time could be determined was 9.25 weeks; however, 100 percent were confirmed to RTA to some degree. The RTA of dancers and runners (the largest portion of the cohort at 76) was around 8 weeks, whereas soccer players were the slowest at >16 weeks. There was no other significant difference in RTA between sport, sex, or grade of hallux limitus/rigidus except for between runners and soccer players. Six patients indicated a decreased desire to activity with five having prior surgery.

From the article of the same title
The Journal of Foot & Ankle Surgery (07/01/2019) Vol. 58, No. 4, P. 609 Saxena, Amol; Valerio, Dallas L.; Behan, Shontal A.; et al.
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Toe Pressure in Predicting Diabetic Foot Ulcer Healing: A Systematic Review and Meta-Analysis
It is estimated that early detection and appropriate treatments may prevent up to 85 percent of amputations related to diabetic foot ulcers (DFU). Toe blood pressure (TBP) is a quick and portable bedside assessment and is less affected by medial sclerosis of arteries present in the diabetic population compared to other measurements like ankle-brachial index. A systematic review was conducted to assess the sensitivity and specificity of toe pressure in prediction of DFU wound healing using randomized control, prospective, and retrospective trials if they reported healing rates of DFUs with respect to different TBP readings. Healing was defined to be intact skin for at least six months or at time of death. A total of eight studies (six prospective and two retrospective) inclusive of 909 patients were eligible for inclusion. It was found that a TBP of more than 30mmHg is associated with a sensitivity and specificity of 0.86 and 0.58, respectively, for healing of diabetic foot ulcers. A TBP of more than 30mmHg is sensitive but not specific in the prediction of healing of DFUs. TBP's portability and quick analysis make it appropriate for use as a bedside assessment to complement current clinical parameters to aid in predicting the healing of DFUs.

From the article of the same title
Annals of Vascular Surgery (06/18/19) Tay, Wei Ling; Lo, Zhiwen; Hong, Qiantai; et al.
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Practice Management

Build Employee Trust Through Effective Communication
Communication is critical when it comes to building trust with your employees, which is foundational to any kind of leadership. Good staff communication is clear, concise, courteous and consistent in timing and tone. Communication should also be open and honest, free of half-truths and embellishments, as withholding information can breed distrust and disrespect.

From the article of the same title
Physicians Practice (06/19/19) Norris, David J.
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How to Create a Vibrant Culture in Your Private Practice
The American Medical Association (AMA) offers an open-access platform called STEPS Forward, which aims to help physicians develop and guide a cohesive and efficient team. The platform consists of over fifty modules containing strategies, insights and practical resources, most of which focus on specific activities that will flow from a change-ready practice culture. One module addresses how to use an organizational approach to create an optimized practice environment, while another discusses how to prioritize and select which changes to focus on. These sections advise defining a vision for the practice, communicating that vision and creating a practical and documented pathway to achieve it. Moreover, because it is critical to promote a team culture while pursuing change, there are several program modules dedicated to strengthening team cohesion and engagement. Those modules recommend diagnosing the current practice culture, inviting input from team members when coming up with solutions, and working with the entire practice to develop a team compact, or a collaborative document that sets the ground rules on how team members should treat one another.

From the article of the same title
American Medical Association (06/21/19)
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MedPAC Wants to End 'Incident-to' Billing by APRNs, PAs
In an annual report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended eliminating the policy of “incident-to” billing, which lets medical practices bill at higher physician rates for services provided by certain medical professionals, including advanced practice registered nurses (ARPNs) and physician assistants (PAs). MedPAC says this policy undervalues the expanded role of ARPNs and PAs, who are reimbursed at a lower rate than physicians, adding ARPNs and PAs should instead consistently bill Medicare under their own provider identifier. By doing so, the commission estimated the government could reduce Medicare spending by up to $5 billion in five years.

The American Medical Association opposed MedPAC's proposal, which it says would “further compartmentalize and fragment healthcare delivery,” while the American Association of Nurse Practitioners (AANP) and the American Academy of Physician Assistants (AAPA) both endorsed the proposal strongly. They note incident-to billing can hide the volume, types or quality of medical services PAs deliver to patients and argue that shedding the policy's administrative burden could offset the revenue lost if Congress were to act on MedPAC's recommendation. MedPAC said its recommendations are intended to reflect the expanded role of APRNs and PAs and not to alter how healthcare is delivered.

From the article of the same title
Medscape (06/24/19) Young, Kerry Dooley
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Health Policy and Reimbursement

A New Trump Order May Make More Healthcare Prices Public
The White House has released an executive order intended to require insurance companies, doctors and hospitals to tell patients the exact cost of their care before they receive it. The executive order requires hospitals and insurers to disclose the actual amount insurers have agreed to pay healthcare providers for care. As high-deductible health plans have become more common, more patients must pay these negotiated prices until their insurance kicks in. The order also asks government agencies to streamline how quality-of-care information is gathered and reported, making it easier for patients to compare doctor and hospital performance alongside their prices. The order, which has no force of law on its own, leaves regulators to determine the exact information hospitals and insurers will have to disclose, as well as the extent of the disclosure.

The administration says the order could help protect patients from a predatory health industry and increase market and social pressure on healthcare providers to lower their prices. Some experts are skeptical about how pricing information will drive down overall costs, citing evidence from earlier experiments the information does not help patients price-shop or save money. Others say forced transparency could distort existing healthcare markets rather than improving them. Insurers and hospitals are expected to challenge the order in court, as they have done with similar state laws.

From the article of the same title
New York Times (06/24/19) Abelson, Reed; Sanger-Katz, Margot
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Supreme Court to Consider Lawsuit over Affordable Care Act Payments to Health Insurance Companies
The Supreme Court has added an appeal from health insurance companies to its 2019-2020 docket. The appeal alleges that the federal government owes health insurance companies $12 billion from losses sustained because of the Affordable Care Act (ACA), which included three risk mitigation programs intended to shield health insurers from losses for a three-year period. The risk mitigation program created a central fund for insurers, who could draw from it if consumers' claims exceeded their premiums. For the first few years ACA was law, insurers miscalculated what their premiums should be and consequently lost billions of dollars. But when insurers sought to draw from the central fund, they found that new legislation required the risk corridor to be budget-neutral and were therefore given only a fraction of what they had requested to alleviate their losses.

After receiving mixed reactions from lower courts, Moda Health Plan, Blue Cross and Blue Shield of North Carolina, Land of Lincoln, and Maine Community Health Options petitioned the Supreme Court to hear their appeal. The U.S. Chamber of Commerce, the National Association of Insurance Commissioners, and attorneys general in multiple states have filed amici briefs supporting the insurers.

From the article of the same title (06/24/19) Luhby, Tami
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Voters Have Big Healthcare Worries, but Not the Ones Democrats Are Talking About
As 23 candidates jockey for top position in the race to win the Democratic primary ahead of the 2020 presidential election, healthcare has come to the forefront of the national debate. Three different 2019 polls found that voters are more likely to trust Democrats with crafting healthcare policy than Republicans, but there is some disconnect between voter preferences and party policy. Voters consistently report that they want to pay less for healthcare—but Democratic emphasis on universal coverage,like the Medicare-for-All plan,would be costly to implement. Harvard professor Robert J. Blendon cautions Democratic candidates not to be caught up in promoting access to coverage, the issue that dominated in the 2008 and 2016 elections, over affordable coverage, which he sees as a much more pressing issue approaching 2020.

From the article of the same title
Washington Post (06/21/19) Goldstein, Amy
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Medicine, Drugs and Devices

Pros and Cons of Electronic Prior Authorizations, Prescribing
In an effort to decrease wait times for patients to receive prior authorization for medications, CMS has proposed a new rule requiring electronic prior authorization (ePA) updates for all Medicare Part D plans. These plans would adopt the National Council for Prescription Drug Plans SCRIPT standard, enabling prescriptions to be requested via an electronic prescribing (eRx) system or an eRx-enabled electronic health record system. Prescribers would be notified of prior authorization requirements and instruct the provider to fill out needed information for an ePA. Providers would also get feedback in real-time to confirm whether the request was approved.

From the article of the same title
HealthPayerIntelligence (06/24/19) Waddill, Kelsey
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Senate Finance Leaders in Talks on Deal to Limit Drug Price Increases
The Senate Finance Committee is searching for a bipartisan deal to limit drug price increases in Medicare, according to sources familiar with the talks. Sen. Ron Wyden (D-Ore.) originally proposed a plan in which drug companies must pay back rebates to Part D, Medicare's prescription drug program, if prices rise faster than inflation. Another measure tied to the talks would require drug companies to pay money to Medicare if they introduce a new drug at a high cost. Finance Committee Chairman Sen. Chuck Grassley (R-Iowa) confirmed he is involved in the talks, but both he and Wyden refused to divulge specifics about the negotiations except they are striving for a bipartisan agreement. There is growing support in Washington for taking action on drug pricing, but the measure faces some degree of opposition from many Republican lawmakers reluctant to come close to price controls for pharmaceutical companies.

From the article of the same title
The Hill (06/26/19) Sullivan, Peter
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Two Senators Introduce Bill Giving Patients More Control of Data
U.S. Senators Amy Klobuchar and Lisa Murkowski have introduced legislation to give patients more control over their own health data by protecting it from third party companies. The senators argue that current laws fail to account for growing privacy concerns as new technologies, such as health apps and genetic testing kits, grant companies greater access to patient health data. The Protecting Personal Health Data Act would enable consumers to handle their own health privacy options, which include accessing, amending or deleting a copy of the personal health data that companies use. Provisions of the bill would include appropriate standards for consent accounting for differences in sensitivity between genetic data, biometric data and general personal health data. The bill would also create a task force to address the cybersecurity risks, privacy concerns and the long-term effectiveness of de-identification methods for genetic biometric. This task force would also work to formulate security standards for consumer services and educate patients about direct-to-consumer genetic testing.

From the article of the same title
Health Data Management (06/25/19) Goedert, Joseph
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, AACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS

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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of This Week are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS and does not imply endorsement of any view, product or service by ACFAS.

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